Key result
Strain rate imaging demonstrated reduced biventricular deformation in Marfan syndrome patients compared to controls, including lower left ventricular radial strain (70% vs 93%, P<0.001).
Why the study?
Does strain rate imaging detect biventricular dysfunction more accurately than conventional echocardiography in adult unoperated patients with Marfan syndrome?
Cross-Sectional (n=93)
Does strain rate imaging detect biventricular dysfunction more accurately than conventional echocardiography in adult unoperated patients with Marfan syndrome?
Absolute Event Rate: 70% vs 93%
p-value: p=<0.001
Strain rate imaging reveals a uniform reduction in biventricular deformation in Marfan syndrome patients and offers higher sensitivity and specificity for detecting dysfunction compared to conventional echocardiography.
Strain rate imaging may detect subclinical biventricular dysfunction in Marfan syndrome; leaves open superiority over conventional echocardiography.
OBJECTIVE: To investigate the presence of any regional myocardial deformation abnormalities in Marfan syndrome (MFS) and determine the benefits of using advanced echocardiography compared to conventional techniques. BACKGROUND: Myocardial dysfunction in MFS may be caused by extracellular matrix remodeling thus, resulting in uniform reduced functionality. However, increased aortic stiffness may cause segmental ventricular abnormalities. Strain rate imaging (SRI) constitutes a validated technique to assess regional deformation in various clinical conditions. With this in mind, we aimed to investigate biventricular function in MFS using SRI. METHODS: Forty-four MFS patients (mean age 30 ± 12 years, 26 men) and 49 controls without valvular disease were examined using SRI. Ejection fraction (EF) was calculated by the Simpson's biplane method. Biventricular deformation was assessed by measuring strain/strain rate. Strain values were divided by left ventricular (LV) end-diastolic volume to adjust LV deformation for geometry changes providing a strain index (SI). Aortic stiffness was evaluated using the β-stiffness index. RESULTS: EF (%) was reduced in MFS patients (59 ± 5 vs 72 ± 4, P < 0.001), whereas β-stiffness was increased (P < 0.001). LV radial and LV and right ventricular (RV) long-axis strain values (%) were reduced in the patient group (70 ± 17 vs 93 ± 10; 19 ± 2 vs 25 ± 2; 30 ± 9 vs 36 ± 8, respectively, P < 0.001). Strain rate measurements were also reduced (P < 0.001). In a multiple regression analysis, MFS diagnosis was negatively associated with LV SI (-0.262 [-0.306, -0.219], P < 0.001). β-Stiffness was negatively associated with SI obtained from the septum, inferior and anterior walls. ROC analyses demonstrated that SRI, when compared with conventional echocardiography, had higher sensitivity and specificity in predicting biventricular dysfunction in MFS. CONCLUSIONS: Our study showed a uniform reduction in biventricular deformation in MFS. These findings suggest that assessment of myocardial function using advanced echocardiographic techniques could be more accurate in MFS patient evaluation than conventional echocardiography alone.
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Kiotsekoglou et al. (2011) conducted a cross-sectional in Marfan syndrome (n=93). Strain rate imaging (SRI) vs. Controls without valvular disease / Conventional echocardiography was evaluated on Left ventricular radial strain (p=<0.001). Strain rate imaging demonstrated reduced biventricular deformation in Marfan syndrome patients compared to controls, including lower left ventricular radial strain (70% vs 93%, P<0.001).
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